Healthcare Provider Details

I. General information

NPI: 1134193782
Provider Name (Legal Business Name): DRS MELCHER AND SPRAGUE OPTOMETRISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E STANLEY ST
THORP WI
54771-9649
US

IV. Provider business mailing address

PO BOX 468
THORP WI
54771-0468
US

V. Phone/Fax

Practice location:
  • Phone: 715-669-5631
  • Fax:
Mailing address:
  • Phone: 715-669-5631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM ROBERT SPRAGUE
Title or Position: PRES
Credential: OD
Phone: 715-669-5631